For the past 20 years, “means-tested” welfare and Medicaid spending has grown faster than the economy, population growth, the poverty rate, and expenditures in education and transportation. On average, health-care and welfare systems command the largest share of state budgets, about 30 percent, requiring the labor of barely two workers in both private and public sectors for every single recipient of welfare, including Medicaid. In some states, that share is more than 40 percent. The pressures of the Affordable Care Act, coupled with the trajectory of welfare spending, will push the number to at least 50 percent by 2025. Unless they reverse these trends, states will struggle to invest in job creation through infrastructure, tax relief, research, business development, education, and vocational training.

Responding to the Welfare Squeeze

The Alexander Group (AG)is the only consulting firm that delivers the solution: comprehensive redesigns of public-welfare systems to improve efficiency, effectiveness, value, and quality. AG possesses unique expertise in health and human services policy, management, financing, and analysis—including two decades of turning around large-scale state systems by creating, implementing, and managing reforms that saved money and improved quality and performance while reducing fraud, waste, and abuse. Founded by reformer Gary D. Alexander, the firm offers to all states the same pragmatic solutions that saved billions of dollars and improved service quality in Rhode Island and Pennsylvania. We are the only group of public officials who have designed, implemented, and managed nationally acclaimed reforms like the Rhode Island Global Medicaid Waiver and, in Pennsylvania, The Enterprise-Wide Program Integrity Plan and The Health and Human Services County Block Grant.

Rather than remediate complex and outdated welfare programs piecemeal, we help states reform and restructure their entire systems. Deploying cost-effective savings methodologies to ensure a value-, transparent-, and efficiency-based system, our reforms enhance competition, drive innovation, improve service quality and performance, incentivize accountability and personal responsibility, modernize operations, and root out fraud, waste, and abuse. We also address the Achilles’ heel of welfare systems: their displacement of marriage and fathers—indispensable socioeconomic resources—from families.

At the core of our model is 1) a global reform encompassing all welfare programs and 2) an enterprise-wide program-integrity initiative. Both involve the alignment of all Medicaid and welfare departments, divisions, and programs to support service-delivery and business processes that achieve the goals of a single performance-driven redesign. Because Medicaid interfaces with all aspects of the system, a plan providing maximum flexibility to reform Medicaid within the entire enterprise is necessary.

Our Diagnosis Tool: STEP

Team AG begins with the STEP, or Strategic and Tactical Econometric Programmatic analysis, a unique and comprehensive “first-step” that analyzes the entire enterprise. By helping a state identify root causes of underperformance, STEP enables us to design a strategy to make a state welfare system efficient, cost-effective, and quality based. STEP is the first step of transforming bloated bureaucracies into performance-based agencies that will improve productivity and deliver value.

Streamlining Medicaid and Welfare through a Global Redesign

AG then helps a state design, develop, and implement innovative strategies that will contain costs, improve service quality and performance, ensure delivery of appropriate services, increase transparency, and improve recipient satisfaction. Because almost all states operate multiple Medicaid and other program waivers with conflicting service definitions and redundant and burdensome rules, our goal is a system consolidated into a single and flexible global waiver, perhaps two, focused on:

  • Long-term care redesign across all populations that focus on independence
    •  Care-management reforms across all populations that improve quality
    •  Competitive and performance-based contracting and payment methods that drive accountability
    •  Data analytics, transparency, reporting and score cards
    •  Connecting payers to providers to pay for true cost, lower prices, and drive transparency
    •  Pragmatic savings initiatives that decrease the burden on the state
    •  Employment programs that create self-sufficiency
    •  Exploring the possibility of greater access
    •  Incorporating all public-welfare programs
    •  Information technology and eligibility system enhancements and redesigns

 An ‘Independence’ Strategy that Dismantles the Welfare Cliff

As Team AG was the firm to first quantify and coin the term, our global redesign seeks to dismantle the “welfare cliff”—the incentives of the current system that weaken American norms—so that more children and adults can benefit from living in self-supporting, intact families. Consequently, our “independence” strategy builds upon the “founding principles” of U.S. social welfare policy that 1) reinforced the family as the fundamental unit of society, the first source of support for adults and children; 2) recognized “the fundamental rights of children” to a rich home life and childhood, including an intact family; and 3) understood the best welfare system promotes not dependency but independence through a “family-wage” job that is able to fully support both mother and father and children.

 Enhancing Program Integrity, Changing the System Culture

Finally, AG designs an enterprise-wide program-integrity initiative plan to minimize fraud, waste, and abuse so that safety-net programs and resources are directed to the truly needy. It also ensures that all Medicaid and welfare services are properly aligned—delivered in the right place, time, and setting. The result: millions of dollars in savings that can be repurposed back into the system to incentivize responsible life choices or used for other state purposes. This aspect of reform redesigns IT systems to quickly identify fraud, waste, and abuse and crafts a business-process reengineering plan for department or agency operations that will break down silos, improve performance, and change the organizational culture.

A centralized enterprise process with clear goals, objectives, performance measures, and outcomes is critical to enhancing program integrity. AG conducts an exhaustive environmental inventory and assessment of health and human service processes, policies, IT systems, structures, performance measures, and personnel. We identify areas of improvement and resource mapping to synthesize all resources, and then develop a vision and strategic plan for improving, enhancing, and defining the program-integrity framework. That framework will ensure that policies, rules, and information technology not only comports with goals and objectives but also drives continuous improvement to reduce fraud, waste, and abuse throughout the entire system.

 Better Outcomes for States

Our expertise enables us to see the big picture—the interactions among all the various components of welfare and Medicaid operations—identify strengths and weaknesses—and create tested and proven global solutions that work. By designing and implementing improved processes and solutions, we help states achieve better outcomes, contain costs and save money, improve quality for the recipients, and repurpose state funds to provide a brighter future for states and their people.